In case of emergency

Department poised to meet growing needs

Stanford Hospital's Emergency Department is the only level-1 trauma center between San Francisco and San Jose. One out of every four patients treated in the Emergency Department is from Palo Alto.

Walking through Stanford Hospital & Clinics’ Emergency Department can be a traumatic experience. Exam rooms are crammed with patient beds and equipment. Hallways are narrowed with more beds, gurneys and equipment. Somehow the medical staff manages to maneuver through the space that remains.

Bob Norris, MD, an associate professor of surgery, presides over the Emergency Department, and in the last few months, he has been sharing the hard numbers that reflect the disparity between the existing space and a patient need that just keeps growing.

The history is simple: The hospital’s emergency room is vintage 1976. It was designed for 30 patient beds—enough to care for 70 people daily. Today between 125 and 150 people arrive in need of medical treatment each day.

The number of patients who come through the emergency room doors has been climbing steadily since 2003. In fiscal year 2007, there was a total of 44,000 visits by adults and children, a 4 percent increase from the prior year. So far this year, the increase is about 5 percent.

In planning the department, no one envisioned a designated trauma center, where the most advanced equipment and experienced staff would be available for patients with the most serious medical needs. The Stanford Hospital Emergency Department is the only Level 1 trauma center between San Jose and San Francisco, a facility staffed with specialists for the most dire injuries or illnesses. The likelihood that Emergency Department patients will need admission to the hospital is triple that of a community hospital emergency room. Being treated at a Level 1 trauma center improves a patient’s chances of survival by 20 percent or more.

The Emergency Department is operating at or above capacity 90 percent of the time.

One out of every five patients in Stanford’s Emergency Department is a child. The department has a fully equipped pediatric section. A special waiting room ensures that families who may have had to bring other children with them can be together in a warm, comforting environment. A recent Institute of Medicine report found that adequate emergency pediatric care is a rare feature in American hospitals.

One out of every four patients treated for emergencies is from Palo Alto, so local residents don’t have to venture far when they are in medical trouble and need quick attention.

Ninety percent of the time, the department is operating at or above capacity, even with 18 beds added through the creative use of existing space. When all the beds are full, the department cannot accept new arrivals for limited periods of time, except for trauma patients. Last year, the Emergency Department deferred ambulances from Santa Clara County to other hospitals a total of 222 hours. It diverted patients coming from San Mateo County 370 hours during the same period.

The department also lacks surge capacity, a significant concern in the event of a major earthquake, bioterrorism event or pandemic flu.

“We need more than Band-Aids,” said Paul Auerbach, MD, a clinical professor of surgery in the Division of Emergency Medicine. “We never know what’s coming through the doors—it could be a child with an earache or a transplant patient in organ rejection.” Often the department is so overwhelmed that he tells the staff, “Put on your track shoes and get ready to run.”

The medical center’s planned renewal project includes significant expansion for the Emergency Department. Last November, Silicon Valley entrepreneur Marc Andreessen and his wife, Laura Arrillaga-Andreessen, pledged $27.5 million to help build a state-of-the-art Emergency Department that will double its current size, add new technologies and increase staff to include a patient advocate program. The gift also includes an endowed position for a medical director of disaster preparedness.